Self-report adherence measures in chronic illness: retest reliability and predictive validity.
BACKGROUND
Patient self-report is a practical method for measuring adherence, but little is known about its optimal use.


OBJECTIVE
To examine the retest reliability and predictive validity of 3 different types of self-report adherence measures among patients with common chronic illnesses.


METHODS
Correlation and regression analyses of data from an ongoing randomized controlled trial.


METHODS
Patients (N = 415) aged >or=40 years recruited from a primary care network with arthritis, asthma, chronic lung disease, congestive heart failure, depression, and/or diabetes mellitus, plus impairment in >or=1 basic activity and/or a score of >or=4 on the 10-item Center for Epidemiologic Studies Depression Scale.


METHODS
: Self-report adherence (administered variously at baseline, 2, 4, and 6 weeks, and 6 months): number of pills taken/number of pills prescribed (PT/PP), using 1-7 days recall, and global reports of medication adherence and overall adherence tendencies. Six-month functional outcomes: Health Assessment Questionnaire (HAQ) and Short Form-36 (SF-36).


RESULTS
Correlation coefficients among contemporaneously administered 1-7 days PT/PP measures were >or=0.78. Correlations among PT/PP measures and global adherence measures, and among PT/PP measures at 2 and 4 weeks, ranged from 0.11 to 0.54. PT/PP measures using >or=3-4 days recall significantly predicted adjusted 6-month HAQ but not SF-36 score.


CONCLUSIONS
Self-report PT/PP and general medication adherence measures tap different behavioral constructs. Self-reported PT/PP at a given point in time is not necessarily representative of medication adherence over time. Among chronically ill patients, 3-4 days recall of PT/PP yield adherence estimates, which are practically as reliable and valid as longer intervals and which predict functional outcomes.
Jerant
Anthony
A
Department of Family and Community Medicine, University of California Davis School of Medicine, Sacramento, California, USA. afjerant@ucdavis.edu
DiMatteo
Robin
R
Arnsten
Julia
J
Moore-Hill
Monique
M
Franks
Peter
P
D000328:Adult; D002908:Chronic Disease / Q000188:drug therapy*; D003625:Data Collection / Q000379:methods*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D011939:Mental Recall; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis; D015203:Reproducibility of Results; D012959:Socioeconomic Factors